Robot-assisted Minimal Invasive CABG Using Bilateral Thoracic Arteries

Robot-assisted minimal invasive CABG using bilateral thoracic arteries Algoet Michiel, MD1; Wouter Oosterlinck, MD PhD1 1Department of Cardiovascular sciences, research unit cardiac surgery, KU Leuven, Leuven, Belgium

BACKGROUND

Robotically-assisted minimal invasive direct coronary artery bypass (RA-MIDCAB) is an attractive strategy for coronary revascularization, although bilateral internal thoracic artery (BITA) grafting is complex it allows us for total left sided arterial revascularization.

METHODS

The RA-MIDCAB technique involves robotic internal thoracic artery harvesting followed by a manual anastomosis performed through a mini-thoracotomy. We analyzed all off-pump CABG and RA- MIDCAB coronary surgery using BITA from 01/01/2015 – 31/10/2022, propensity score matching (PSM) was performed. Primary outcomes are major adverse cardiovascular and cerebrovascular events (MACCE) and mortality. Secondary outcomes are surgical parameters a length of hospital stay. We also checked for effects of learning curve.

RESULTS

We included 601 OPCAB and 75 RA-MIDCAB procedures, after PSM this resulted in 2 cohorts of 54 patients. Mortality and MACCE survival analysis showed no significant difference. Surgery time is significant longer in the RA-MIDCAB group, but decreases after 40 cases (p less than 0.01). There is less blood transfusion in RA-MIDCAB (p=0.02), less (p less than 0.01) intensive care unit (ICU) admissions , shorter ICU stay and shorter hospital stay in respectively RA-MIDCAB vs OPCAB. CONCLUSION: This is a first publication of 75 consecutive RA-MIDCAB BITA harvesting for left ventricular wall revascularization. It is a safe technique, the advantages are shorter length of hospital stay, less ICU admissions and less blood transfusion. This technique expands the surgical coronary revascularization group and improves their outcomes.